June 13, 2014

Saudi pledge for transparency on MERS welcomed

Riyadh: Michael Osterholm, Director of the Centre for Infectious Diseases Research and Policy at the University of Minnesota, says Saudi authorities should be congratulated on their pledge to be more open. “From talking to people inside the kingdom right now, I’d say there is a very new sense of transparency in the last few weeks,” he said.

However, challenges remain. The problems are evident in the case of one kidney patient who fell ill in Jeddah in April, a main location of the outbreak.

The man was transferred from another hospital to the King Faisal Specialist Hospital (KFSH), but doctors there were not officially informed by medical staff who had previously cared for him that they suspected he might have contracted Mers, said a city health source.

As a result, King Faisal Specialist Hospital staff took no extra precautions and, within a week, the head of the intensive care unit and other staff, including a pregnant nurse, fell ill.

Both the nurse and ICU head have now recovered.

The problem was that suspicions of Mers were only communicated verbally, rather than being put on paper in a patient’s file, said Sabah Abu Zinadah, a former head of nursing for a government commission on health care workers.

The King Faisal hospital spokesperson declined to comment.

Such problems were familiar to people inside Saudi Arabia who had been involved in cases of Mers over the previous two years.

“At first the government would only accept that those patients already in intensive care had Mers. Even when cases were coming to the emergency room with severe respiratory symptoms they were told to go home and not investigated,” said the head of a private hospital where some Mers cases came to light last year.

He denied that there was any deliberate attempt to hide Mers cases, but said officials — and sometimes emergency room doctors — found it hard to accept that a new disease had raised its head in their hospital. The hospital declined to comment.

He said the extent of the outbreak in Jeddah in April and May showed that complacency had set in after the rate of infection slowed throughout last summer, autumn and winter, and when there were no confirmed cases during last year’s pilgrimage season. “We did not learn from the outbreak last year. The health ministry did not get the severity of the issue. But it was not just them who underestimated it. Even in the best private hospitals, there were cases,” he said.

COMPLEX SYSTEMS

Abu Zinadah said nursing groups in the kingdom had warned the health ministry about systemic problems in hospitals and poor government oversight.

She said they had called for better enforcement of infection control procedures — something Madani says is now being implemented — and independent regulators for hospitals and health care professionals.

The only official body now overseeing health care workers is the Saudi Commission for Health Specialities, whose board is chaired by the minister. According to its website, it is responsible only for training and setting standards, not for regulating or evaluating performance.

Hospital regulation is run by the health ministry, which also manages many of the country’s hospitals.

Other hospitals are run by private health care companies and by other state bodies, adding to the complexity of the system.

“It’s a complicated country. Even people like Memish [the deputy minister sacked recently] don’t really have access to everything [in terms of patient data and information],” said Christian Drosten, a University of Bonn virologist who has worked on Mers with Saudi scientists.

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Riyadh: Michael Osterholm, Director of the Centre for Infectious Diseases Research and Policy at the University of Minnesota, says Saudi authorities should be congratulated on their pledge to be more open. “From talking to people inside the kingdom right now, I’d say there is a very new sense of transparency in the last few weeks,” he said.

However, challenges remain. The problems are evident in the case of one kidney patient who fell ill in Jeddah in April, a main location of the outbreak.

The man was transferred from another hospital to the King Faisal Specialist Hospital (KFSH), but doctors there were not officially informed by medical staff who had previously cared for him that they suspected he might have contracted Mers, said a city health source.

As a result, King Faisal Specialist Hospital staff took no extra precautions and, within a week, the head of the intensive care unit and other staff, including a pregnant nurse, fell ill.

Both the nurse and ICU head have now recovered.

The problem was that suspicions of Mers were only communicated verbally, rather than being put on paper in a patient’s file, said Sabah Abu Zinadah, a former head of nursing for a government commission on health care workers.

The King Faisal hospital spokesperson declined to comment.

Such problems were familiar to people inside Saudi Arabia who had been involved in cases of Mers over the previous two years.

“At first the government would only accept that those patients already in intensive care had Mers. Even when cases were coming to the emergency room with severe respiratory symptoms they were told to go home and not investigated,” said the head of a private hospital where some Mers cases came to light last year.

He denied that there was any deliberate attempt to hide Mers cases, but said officials — and sometimes emergency room doctors — found it hard to accept that a new disease had raised its head in their hospital. The hospital declined to comment.

He said the extent of the outbreak in Jeddah in April and May showed that complacency had set in after the rate of infection slowed throughout last summer, autumn and winter, and when there were no confirmed cases during last year’s pilgrimage season. “We did not learn from the outbreak last year. The health ministry did not get the severity of the issue. But it was not just them who underestimated it. Even in the best private hospitals, there were cases,” he said.

COMPLEX SYSTEMS

Abu Zinadah said nursing groups in the kingdom had warned the health ministry about systemic problems in hospitals and poor government oversight.

She said they had called for better enforcement of infection control procedures — something Madani says is now being implemented — and independent regulators for hospitals and health care professionals.

The only official body now overseeing health care workers is the Saudi Commission for Health Specialities, whose board is chaired by the minister. According to its website, it is responsible only for training and setting standards, not for regulating or evaluating performance.

Hospital regulation is run by the health ministry, which also manages many of the country’s hospitals.

Other hospitals are run by private health care companies and by other state bodies, adding to the complexity of the system.

“It’s a complicated country. Even people like Memish [the deputy minister sacked recently] don’t really have access to everything [in terms of patient data and information],” said Christian Drosten, a University of Bonn virologist who has worked on Mers with Saudi scientists.